Migraine

A severe headache, typically lasting 4–72 hours, accompanied by visual disturbances and/or nausea and vomiting. Migraine attacks may be isolated or may recur at varying intervals. There is no single cause of migraine, although it tends to run in families. Stress-related, food-related, or sensoryrelated factors may trigger an attack. Menstruation and oral contraceptives may also trigger migraine. There are 2 types: migraine with aura (an impression of flashing lights and/or numbness and tingling), and migraine without aura. In migraine without aura, there is a slowly worsening headache, often on one side of the head, with nausea and sometimes vomiting. In migraine with aura, there may be visual disturbances for up to an hour, followed by a severe one-sided headache, nausea, vomiting and light-sensitivity. Other temporary neurological symptoms, such as weakness in one half of the body, may occur. Diagnosis is usually made from the history and a physical examination. Treatment for an attack is an analgesic drug such as aspirin or paracetamol, plus an antiemetic drug, if needed. If this is not effective, treatment with serotonin agonists such as sumatriptan may be prescribed. Ergotamine may prevent an attack if taken before the headache begins, but is now rarely used. Sleeping in a darkened room may hasten recovery. For frequent attacks, preventive treatment may be needed. Keeping a diary can help pinpoint trigger factors, and prophylactic drugs may be prescribed. (See also cluster headaches.)